CMS: Romania adopts law on personal contributions for private medical services

The Romanian Government recently adopted Emergency Ordinance no. 54/2021 that amends Law 95/2006 on health reform.

According to the new legislation, which came into force on 25 June 2021, patients may opt for private health services from private providers that have concluded contracts with health insurance houses and pay personal contributions. These personal contributions will cover the difference between the tariff charged by the private provider for resolving a case (or the tariff for the medical services provided) and the corresponding tariffs borne from the national health insurance fund budget.

The actual difference is defined in the framework contract for the provision of medical services approved by Government Decision 696/2021 and applicable for the years 2021 to 2022. As for medical services, the personal contribution of the insured is calculated according to the difference between the tariff charged by the private provider for solving the case and the amount resulting from the multiplication of the relative value of the case (in Romanian: “valoarea relativa a cazului”) with the tariff per adjusted case (“tariful pe caz ponderat” or “TCP”) specific to the hospital.

For transparency reasons, private providers must display the personal contribution on their internet page and at their headquarters. Also, the insured party can pay the personal contribution directly or based on a contract with an insurance company.

The provision regarding personal contributions for medical services (provided as part of continuous hospitalisation) came into force on 1 July 2021. The provisions regarding personal contributions for services provided in specialised outpatient clinics and in specialised paraclinical outpatient clinics will come into force 60 days after the adoption of the state budget for 2022.